Campaign for the Fortification of Flour with Folic Acid

We’re nearly there!

In September 2021, the UK Government along with the governments in Wales, Northern Ireland and Scotland announced its intention to introduce mandatory fortification of non-wholemeal flour with folic acid.

We’re not quite over the line yet as there has been further consultation about the quantity of folic acid that should be added. Once we know the outcome of the consultation, we should also have an idea of when implementation will begin across the UK.

Why is folic acid so important?

Long standing research has shown increasing your folic acid intake prior to conception reduces the chances of a Neural Tube Defect (NTD) developing during pregnancy.

Whilst current guidelines recommend that women take a 400mcg dose of folic acid every day for at least three months before trying for a baby, recent statistics show that supplementation is failing to significantly reduce the number of pregnancies affected.

That is not to say it is not effective, but with approximately 40% of UK pregnancies found to be unplanned, it is often a case of ‘too little too late’ in terms of receiving the necessary advice and support.

By adding folic acid to flour, it will give that little bit of extra help in reducing the number of pregnancies affected by Spina Bifida or Anencephaly.

Folic acid facts:
  • Folic acid has been proved to reduce the chance of pregnancy affected by NTD 
    It needs to be taken well before conception to work - supplements have not been successful.
  • Only 31% of women take the right dose at the right time, with many more not starting until they’re already pregnant, when it’s too late.
  • Around 75% of women of childbearing age have blood folate below the level which protects them best from developing an NTD during pregnancy.
  • Men are often low in folate, not just women.
  • Many teenagers are clinically deficient in folate, risking their long term health.
  • Low folate increases the risk of dementia, depression and anaemia.
  • Folic acid may reduce death by strokes.
  • USA and Canada have fortified for 20 years with reduction in NTD pregnancies by as many as 50% in some areas.
  • Our 80 countries fortify common foods round the world. 
Our journey to fortification:

Shine plans a renewed focus on fortification and launches the 'Fight for Fortification' campaign - a Parliamentary briefing, sponsored by Owen Smith MP (Labour) and Nigel Dodds MP (DUP) takes place at Westminster.

Owen Smith MP leads a Parliamentary Debate, with support from Nigel Dodds MP, Stewart McDonald (SNP), Jessica Morden MP (Lab), Jim Shannon MP (DUP) Lisa Cameron MP (SNP) and Sharon Hodgson MP (Lab).

Informed evidence is presented to the Minister for Public Health, Steve Brine MP.  In response, Steve Brine states that he is keen to meet with Shine - a date is yet to be agreed.  

You can re-watch the debate online here.

An All-Party Parliamentary Group (APPG) on folic acid fortification is formed - MPs are subsequently invited to it's first formal meeting on 11th September 2018. 
An Early Day Motion calling for the mandatory fortification of flour with folic acid is tabled, and MPs encouraged to sign.

You can view the official Early Day Motion online here.

APPG meets, focusing on how living with spina bifida or losing a baby to anencephaly affects individuals and families, and why the Government has to act now to introduce mandatory fortification of flour with folic acid'.

Shine holds a drop in Q & A session in parliament.  An in-depth briefing document is issued to all serving MPs.

Minister for Public Health Steve Brine MP announces that the government is to launch a formal consultation.  When asked by Stewart McDonald MP (SNP) whether the consultation will look at 'whether it should happen, or how it should happen' he replied "We will be taking evidence, including from the committee for toxicity, to look at the safe upper limit of folate levels which I'm particularly keen to get right, but I'm convinced that the evidence is overwhelming and that this is something which we should be doing."

You can view the Government's official announcement online here.

A second parliamentary debate is held in conjunction with World Spina Bifida and Hydrocephalus Awareness Day, with MPs asking questions in order to better understand the detail of the consultation, and to raise specific points of emphasis. 

You can view the debate online here.

The consultation, announced in October by Steve Brine, Minister for Public Health, was not launched in early 2019 as planned.  Shine, and others, kept up the pressure to ensure that the consultation happened, and that mandatory fortification of flour with folic acid remain high on the agenda.   
In a response to a letter from Shine's Chief Executive, the Minister told us: 
"I am sorry I cannot give you a precise date for when the consultation will go live, but my Officials are working on the preparation of the necessary documentation, and we hope to be in a position to launch it as soon as we have the necessary internal clearances to proceed. Please be assured, I am very supportive of moving ahead with it as quickly as we can, but you will appreciate that this is a complex policy that attracts a significant amount of interest from many different stakeholders. 

As such, we need to be sure that what we put out properly represents the policy intention and I need to demonstrate my responsibilities under the Public Sector Equality Duties. This consultation will allow all interested parties to consider the issue and make their representations. Once we have considered the responses, we will be in an informed position to decide the best way forward." 

Questions were also tabled at the House of Lords on Wednesday 9th January. It was clear from the responses that many remained ill-informed about folic acid and its importance. Shine contacting those who responded to questions in a quest to provide them with clear and correct information on the issue. 
You can read a transcript of the discussion here.
June 2019
The UK Government launches the consultation on the proposal to add folic acid to flour. 
September 2019
Shine submits its response to the consultation - see our response here.
Shine also organises and submits a joint consensus statement from influential individuals, organisations and representative organisations to show collective support for mandatory fortification of flour with folic acid - see the consensus statement here.
The Government receives over 1400 responses to the consultation.
November 2019
Shine's CEO writes to all the major political parties ahead of the general election to ask them to show their support and commitment to implementing mandatory fortification of flour with folic acid without delay, should they be elected into Government.

December 2019
The outcome of the consultation should have been announced in December, but the general election delays this. 
The All-Party Parliamentary Group for Folic Acid (APPG) is automatically disbanded in line with parliamentary procedures after a general election. 
Owen Smith (former Labour MP) does not to re-stand as Member of Parliament for Pontypridd and Nigel Dodds (former DUP MP) is not re-elected.

January 2020 
Shine writes to several MPs who have always supported our campaign to request they table parliamentary questions on the results of the consultation.

February 2020
Jess Morden, MP for Newport East, receives the following from the Department of Health 
"The Department published a United Kingdom-wide consultation on the mandatory fortification of flour with folic acid which ran from 13 June to 9 September 2019. A post consultation update was made available on the Gov.UK website. We received 1,442 responses from a wide range of stakeholders. Due to the pre-election period, preparation of the Government response was put on hold. This is now being prepared and further information will be announced in due course. Any decisions will be made in conjunction with the devolved administrations".

Keeping up the campaigning in 2020 and 2021
Shine continues to liaise with key partners, supporting MPs, Health Ministers and Chief Medical Officers and others across the UK to push for an announcement on mandatory fortification.

20 September 2021 – ‘truly a momentous day’
The government publishes its response to the consultation and announces its intention to introduce folic acid to all non-wholemeal flour across the UK.

Read the Government’s response to the consultation here.

Shine were asked to contribute to the Government’s official press release. We spent the day on TV and radio, giving interviews about the significance of this important public health initiative.

Read the UK Government’s announcement here.

February 2023
Many months on from the announcement in September 2021, mandatory fortification of non-wholemeal flour with folic acid has not yet been introduced in the UK.

The government launched a consultation on the Bread and Flour Regulations 1998 and the Bread and Flour Regulations (Northern Ireland) 1998 in August 2022 to consider levels of fortification and timescales for implementation.

See Shine’s consultation response here.

Shine is eagerly awaiting the outcome of the consultation, which is due before the end of February 2023.

December 2023 - Where are we now?
To date, the outcome of the consultation on the Bread and Flour Regulations 1998 and the Bread and Flour Regulations (Northern Ireland) 1998 has yet to be published. In the meantime, Shine is continuing to remind the governments in England, Wales and Northern Ireland of their commitment to introduce mandatory fortification of flour with folic acid and the longer the delay, the more pregnancies are affected by neural tube defects such as spina bifida or anencephaly.

January 2024

The UK government mandate folic acid fortification in flour to be fully implemented by 2026. This landmark achievement comes after Shine's persistent campaigning for over 30 years.

This policy is crucial for preventing neural tube defects such as spina bifida and anencephaly. Shine's CEO, Kate Steele, acknowledges the collective efforts of members, supporters, and partners in reaching this significant milestone and can be read here.

A resolution for global fortification

In addition to our campaign for mandatory fortification of flour with folic acid in the UK, we also lent our voice to a campaign by the International Federation for Spina Bifida and Hydrocephalus, and its partners, calling for the World Health Assembly to adopt a resolution to introduce folic acid fortification across the world. This resolution was adopted in May 2023.  

You can find more information here.

Further information:
January 2023

The Executive Board of the World Health Assembly announces its intention to table the resolution at the 76th World Health Assembly.

Read the resolution here.

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